P1133Prediction of Endoscopic Postoperative Recurrence in Crohn’s Disease: A Nationwide Multicenter Real-World Cohort from China

Background Background & Aims: Endoscopic postoperative recurrence (ePOR) remains a major challenge in Crohn’s disease (CD)1. This largest nationwide multicenter study in China aims to identify key predictors of ePOR from both clinical characteristics and histopathological features at the surgical margins, with the goal of optimizing postoperative management strategies2. Methods This nationwide, multicenter, real-world cohort study included CD patients who underwent curative ileocolonic resection and had postoperative endoscopic follow-up. The rate of ePOR, which was defined as a Rutgeerts’ score of ≥ i2b, within 6-12 months was assessed3. Clinical and pathological predictors were identified, and a nomogram was constructed to predict ePOR risk. Results A total of 389 patients from five tertiary inflammatory bowel disease centers in China who underwent ileocolonic resection between July 2016 and June 2024 were included, among whom 204 (52.4%) had complete pathological data. Preoperative exclusive enteral nutrition (EEN) administered for at least 4 weeks was administered in 34.2% of patients, while prophylactic biologic therapy within 3 months after surgery was initiated in 53.5%. The overall 6-12-months ePOR rate was 24.9%. Independent risk factors for ePOR included prior biologic exposure (OR 2.695, 95% CI 1.605-4.525; P < 0.001) and preoperative albumin <35 g/L (OR 2.095, 95% CI 1.160-3.785; P = 0.014). In contrast, preoperative EEN (OR 0.338, 95% CI 0.188-0.610, P < 0.001) and early postoperative prophylactic biologic therapy (OR 0.503, 95% CI 0.304-0.832, P = 0.007) were associated with a reduced risk. Histopathological predictors included moderate-to-severe lymphoplasmacytic infiltration in the lamina propria (OR 4.924, 95% CI 2.028-11.957, P < 0.001) and lymphangiectasia (OR 4.916, 95% CI 2.395-10.092, P < 0.001). A prediction model integrating clinical and pathological variables (AUROC 0.829) outperformed the clinical-only model (AUROC 0.715, P = 0.001). Conclusion Conclusions: In the era of biologics and perioperative optimization, the 6-12-months ePOR rate in CD patients was 24.9%. A combined clinical-pathological model showed strong predictive performance, but external validation is warranted to confirm its clinical applicability. References: 1. Buisson A, Chevaux JB, Allen PB, Bommelaer G, Peyrin-Biroulet L. Review article: the natural history of postoperative Crohn’s disease recurrence. Aliment Pharmacol Ther. 2012;35(6):625-33 2. Nguyen GC, Loftus EJ, Hirano I et al. American Gastroenterological Association Institute Guideline on the Management of Crohn’s Disease After Surgical Resection. Gastroenterology. 2017;152(1):271-275 3. De Cruz P, Kamm MA, Hamilton AL et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet. 2015;385(9976):1406-17 Conflict of interest: Mr. Hu, Fan: No conflict of interest Huang, Zicheng: No conflict of interest Zhu, Liangru: No conflict of interest Cao, Qian: No conflict of interest Guo, Hong: No conflict of interest Fu, Yu: No conflict of interest Huang, Lingjie: No conflict of interest Xiang, Lingya: No conflict of interest Chao, Kang: No conflict of interest Wang, Chao: No conflict of interest Gao, Xiang: No conflict of interest Chen, Minhu: No conflict of interest